ABSTRACT
Background: The success of a chronic hemodialysis program depends on a good vascular access. Aim: To evaluate the experience with vascular accesses for chronic hemodialysis in pediatric patients. Patients and methods: One hundred fifty one vascular accesses used in 60 pediatric patients (33 female) coming from 2 hemodialysis (HD) centers were analyzed. Results: The average age of admission to the hemodialysis program was 10 years old (range 1.8-15). Forty percent of accesses were internal arterio-venous fistulae (AVF), 58 percent were central venous catheters and 2 percent were grafts. Twenty four patients required a central venous catheter from the beginning since they required immediate dialysis. Twenty patients began dialysis with a permeable AVF and never required another vascular access. Eight small children used a central catheter as the only vascular access and 32 patients required both types of vascular accesses. Eighty seven catheters were used in 34 patients, of which 77 were temporary and 10 permanent. Seventeen patients needed only one catheter and one girl required 15 catheters. The average life span for AVF was 524 days (20-1277), for temporary catheters 34 days (1-76) and for permanent catheters 73 days (9-147). Two years survival of AVF was 95 percent. One month survival for subclavian and jugular catheters was 50 percent. Fifty six percent of AVF had no complications, 12 failed due to insufficient flow and 24 percent had a complication. Of the 87 catheters placed, 75 percent had complications and 22 were electively removed. Conclusions: Arteriovenous fistula is the vascular access of choice for hemodialysis in pediatric patients. Central venous catheters can become an essential access, specially in small children
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Arteriovenous Shunt, Surgical/methods , Renal Dialysis/methods , Catheters, Indwelling/adverse effects , Arteriovenous Shunt, Surgical/adverse effects , Renal Insufficiency, Chronic/therapy , Hemodialysis Units, HospitalABSTRACT
Background: The final objective of every children that is admitted to a program o hemodialysis or peritoneodialysis is to receive a renal graft. Aim: To report the experience in pediatric hemodialysis in two pediatric hospitals in Chile that are reference centers for renal transplantation. Patients and methods: Sixty patients, 55 percent female, aged 2 to 15 years old, admitted to the dialysis and transplant program since 1987, with a creatinine clearance of less than 20 ml/min/l.73 m2, were studied. Results: Twenty percent of children were less than 5 years old at the moment of admittance to the program and 3.3 percent weighed less than 10 kg. Etiologies of end stage renal disease were glomerulopathies in 33.4 percent, reflux nephropathy in 27.7 percent, obstructive uropathy in 13.3 percent, hypoplasia/dysplasia in 10 percent, hereditary problems in 8.3 percent and vascular disorders in 5 percent. Eighty six percent of patients were dialyzed less than 2 years and 5 percent more than 4 years. Fifty percent had received prior medical treatment, 5 percent bad been treated with intermittent peritoneal dialysis, 5 percent with chronic ambulatory peritoneal dialysis and 20 percent presented as a terminal renal failure. Sixty two percent received a renal graft, 25 percent is still on hemodialysis, 3.3 percent switched to chronic ambulatory peritoneal dialysis, 3.3 percent had a recovery of renal function and 6.7 percent died being on hemodialysis. Arterio-venous fistulae were the vascular accesses in 75 percent of patients, double lumen catheters in 50 percent and vein grafts in 5 percent. Malfunctioning or infections were the main complications of arterio-venous fistulae, accounting for 30 percent of hospital admissions. Conclusions: The availability of new vascular accesses and new hemodialysis machines specially designed for chndren, along with specially trained health care personnel, should reduce the mortality and complication rates of hemodialysis in this age group
Subject(s)
Humans , Male , Female , Adolescent , Peritoneal Dialysis/methods , Renal Dialysis/methods , Renal Insufficiency, Chronic/therapy , Catheters, Indwelling/adverse effects , Nutritional Status , Growth Disorders/etiology , Body Composition , Renal Dialysis/adverse effects , Hospitalization/statistics & numerical data , Kidney TransplantationABSTRACT
La hemodiálisis crónica en pediatría comenzó a ser empleada en la década de los años de 1970 y en Chile en la siguiente. Desde entonces cada vez más pacientes con insuficiencia renal terminal utilizan este procedimiento de sustitución. En este artículo se revisan los fundamentos fisiopatológicos básicos de la hemodiálisis y su aplicación en forma de sugerencias y algunos aspectos técnicos del procedimiento, sin pretender una descripción exhaustiva de las técnicas y equipamientos actuales utilizados en el procedimiento
Subject(s)
Humans , Child , Renal Dialysis/methods , Renal Insufficiency/therapy , Arteriovenous Shunt, Surgical/adverse effects , Arteriovenous Shunt, Surgical/instrumentation , Equipment and Supplies , Renal Dialysis/adverse effects , Renal Dialysis/instrumentation , Heparin/therapeutic use , Hypertension/etiologyABSTRACT
Un niño de 9 años ingresó al hospital por anemia severa (hematocrito 18%) y enrojecimiento del ojo derecho, comprobándose en oftalmología que sufría uveítis. La velocidad de sedimentación de los eritrocitos (VHS) era 101 mm * h, ureico 91 mg/dl, depuración plasmática de creatinina 9 ml/min * 1,73 m*, concentraciones séricas de IgG e IgM 2.368 mg/dl y 263 mg/dl respectivamente, sobre los márgenes normales para su edad, con IgA apenas detectable y reducción de las poblaciones de células T. Los ensayos de factor reumatoide, anticuerpos antinucleares y antimúsculo liso dieron resultados negativos. Las actividades de las fracciones C3 y C4 del complemento sérico y el sedimento de orina eran normales. La muestra de la biopsia renal incluía 25 glomérulos, uno totalmente esclerótico, dos con fibrosis periglomerular y los restantes sólo con leve aumento de la matriz mesangial. Había, además, intensa infiltración inflamatoria del intersticio, con estructuras granulomatosas que incluían células gigantes, semejantes observables en reacciones por cuerpos extraños, y cristales PAS positivos en el interior de los lúmenes tubulares. A pesar del empleo de tratamiento esteroidal, el que se complicó al final con un granuloma inflamatorio intracerebral que curó en coincidencia con el uso de antibióticos por vía parenteral, el paciente evolucionó hacia la insuficiencia renal crónica y actualmente está siendo sometido a hemodiálisis, con perspectivas de transplante renal. La uveítis fue tratada con colirios de atropina y esteroides, curando con secuelas mínimas